I would caution everyone to carefully read the new and greatly expanded Infusion Nursing Standard of Practice on Flushing and Locking. There is no evidence that saline as a lock in any of these needleless connectors produces good outcomes. There are 2 randomized controlled trials showing greater complications with saline locking. Another systematic literture review of the issues of saline vs heparin locking revealed only very small studies without enough power to make any recommendations. Based on this evidence, the standard continues to recommend that all catheters be locked with heparin. We do recognize that there are issues with heparin, however there are no alternative locking solutions in single dose containers commerically availabe in the USA. These solutions must be prepared by a compounding pharmacy. I would strongly recommend the continued use of heparin lock 10 units per mL for all CVADs, heparin 100 units per mL for locking implanted ports upon removal of the access needle. Lynn
I believe that negative displacement connectors can also negate the need for heparin.
Gwen Irwin
Austin, Texas
I would caution everyone to carefully read the new and greatly expanded Infusion Nursing Standard of Practice on Flushing and Locking. There is no evidence that saline as a lock in any of these needleless connectors produces good outcomes. There are 2 randomized controlled trials showing greater complications with saline locking. Another systematic literture review of the issues of saline vs heparin locking revealed only very small studies without enough power to make any recommendations. Based on this evidence, the standard continues to recommend that all catheters be locked with heparin. We do recognize that there are issues with heparin, however there are no alternative locking solutions in single dose containers commerically availabe in the USA. These solutions must be prepared by a compounding pharmacy. I would strongly recommend the continued use of heparin lock 10 units per mL for all CVADs, heparin 100 units per mL for locking implanted ports upon removal of the access needle. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861